Pilot study to determine the effectiveness of diamorphine gel to control pressure ulcer pain

Pressure ulcer pain, a common problem among palliative care patients, does not respond well to oral analgesics. There have been case reports in the medical literature describing the successful use of topical opioids for painful skin conditions. So far, these topical opioids have not been compared to placebo. To determine the effectiveness of diamorphine gel to control pressure ulcer pain and compare it with placebo, a randomized, double blind, placebo-controlled crossover trial was conducted in 13 patients with painful grade II or III pressure ulcers. Patients resided on the inpatient unit at St. Christopher's Hospice, London, UK. Seven patients completed the study and provided pain scores before and after diamorphine or placebo gel application. Pain scores improved significantly after diamorphine gel application compared with placebo (P<0.05). Diamorphine gel appears to be an effective treatment for pain caused by stage II or III pressure ulcers. It is probably as safe as placebo in regards to side effects, but a larger study would be required to confirm these results.